Abstracts
Résumé
Cet article examine la stigmatisation et ses conséquences sur les personnes utilisatrices de services en santé mentale. L’auteur présente les résultats de trois programmes d’envergure sur la réduction de la stigmatisation implantés aux niveaux national et international. L’accent est mis sur des expériences du programme pilote canadien de l’Organisation mondiale de la santé de lutte contre la stigmatisation et la discrimination pour cause de schizophrénie (Canadian Pilot Program of the World Health Organization’s Global Program to Fight Stigma and Discrimination Because of Schizophrenia). On en tire des leçons pour de meilleures pratiques en matière de programmes anti-stigmatisation. À ce jour, les expériences suggèrent que les interventions les moins coûteuses sont probablement celles qui visent des sous-populations spécifiques. Des campagnes d’éducation populaire à grande échelle ont été décevantes et ne semblent pas produire de changements significatifs d’attitudes et de comportements. Les approches qui privilégient les contacts avec les personnes utilisatrices de services en santé mentale dans un contexte d’éducation anti-stigmatisation s’avèrent plus prometteuses.
Abstract
This paper reviews stigma and its consequences for mental health consumers, presents results from three large scale stigma-reduction programs that have been implemented at national and international levels, and focuses on the specific experiences of the Canadian Pilot Program of the World Health Organizations Global Program to Fight Stigma and Discrimination Because of Schizophrenia in order to draw lessons for better practices for anti-stigma programming. Experiences to date suggest that the most cost-effective interventions are likely to be carefully targeted to specific sub-populations. Broad-based public education campaigns have been disappointing and are unlikely to produce meaningful change in attitudes or behaviours. Approaches that employ contact with mental health consumers in the context of anti-stigma education appear most promising.
Resumen
Este artículo examina la estigmatización y sus consecuencias en los usuarios de los servicios de salud mental. El autor presenta los resultados de tres programas de gran envergadura, implantados a nivel nacional e internacional, sobre la reducción de la estigmatización. Se hace hincapié en las experiencias del programa piloto canadiense, de la Organización Mundial de la Salud, de la lucha contra la estigmatización y la discriminación por esquizofrenia (Canadian Pilot Program of the World Health Organization’s Global Program to Fight Stigma and Discrimination Because of Schizophrenia). De este programa se obtienen lecciones para mejorar las prácticas en materia de programas contra la estigmatización. A la fecha, las experiencias sugieren que las intervenciones menos costosas son probablemente aquellas que se dirigen a subpoblaciones específicas. Las campañas de educación popular a gran escala han sido decepcionantes y no parecen producir cambios significativos de actitudes y comportamientos. Los enfoques que dan prioridad a los contactos con los usuarios de los servicios de salud mental, en un contexto de educación contra la estigmatización, parecen más prometedores.
Resumo
Este artigo examina a estigmatização e suas conseqüências sobre os usuários de serviços de saúde mental. O autor apresenta os resultados de três programas importantes sobre a redução da estigmatização implantados em nível nacional e internacional. A ênfase deste estudo pousa sobre as experiências do programa piloto canadense da Organização Mundial da Saúde na luta contra a estigmatização e a discriminação por causa da esquizofrenia (Canadian Pilot Program of the World Health Organization’s Global Program to Fight Stigma and Discrimination Because of Schizophrenia). Pode-se tirar lições sobre as melhores práticas em programas de anti-estigmatização. Até hoje, as experiências sugerem que as intervenções menos onerosas são provavelmente as que visam pequenos grupos específicos. As campanhas de educação popular em grande escala foram decepcionantes e não demonstraram produzir mudanças importantes de atitudes e de comportamentos. As abordagens que privilegiam os contatos com os usuários de serviços de saúde mental em um contexto de educação anti-estigmatização são mais promissoras.
Appendices
Références
- Angermeyer, M. C., 2002, From intuition to evidence-based anti-stigma interventions, World Psychiatry, 1, 1, 21-22.
- Arboleda-Flórez, J., 2001, The State of the Evidence : Stigmatization and Human Rights Violations. Mental Health : A Call For Action by World Health Ministries, Geneva, World Health Organization.
- Canadian Mental Health Division, Ontario Division, 1994, Final Report : Mental Health Anti-Stigma Campaign Public Education Strategy.
- Corrigan, P. W., 2002, Empowerment and serious mental illness : treatment partnerships and community opportunities, Psychiatric Quarterly, 73, 3, 217-228.
- Corrigan, P. W., Watson, A. C., 2002, Understanding the impact of stigma on people with mental illness, World Psychiatry, 1, 1, 16-19.
- Crisp, A. H., Gelder, M. G., Rix, S., Meltzer, H. I., Rowlands, O. J., 2000, Stigmatisation of people with mental illnesses, British Journal of Psychiatry, 177, 4-7.
- Crocetti, G., Spiro, H. R., Siassi, I., 1971, Are the ranks closed ? Attitudinal social distance and mental illness, American Journal of Psychiatry, 127, 9, 1121-1127.
- Dain, N., 1994, Reflections on antipsychiatry and stigma in the history of American psychiatry, Hospital and Community Psychiatry, 45, 10, 1010-1014.
- D’Arcy, C., 1987, Opened ranks ? Blackfoot revisited, in Coburn, D., D’Arcy, C., Torrance, G.M., and New, P., eds., Health and Canadian Society (2nd Edition), Richmond Hill, Ontario, Fitzhenry and Whiteside, 281-294.
- Davidson, M., 2002, What else can we do to combat stigma ? World Psychiatry, 1, 1, 22-23.
- Dickerson, F. B., Sommerville, J., Origoni, A. E., Ringel, N. B., Parente, F., 2002, Experiences of stigma among outpatients with schizophrenia, Schizophrenia Bulletin, 28, 1, 143-152.
- Goffman, E., 1963, Stigma : Notes on the Management of Spoiled Identity, Englewood Cliffs, N.J., Prentice-Hall.
- Link, B. G., Mirotznik, J., Cullen, F. T., 1991, The effectiveness of stigma coping orientations : Can negative consequences of mental illness labelling be avoided ? Journal of Health and Social Behavior, 32, 302-320.
- Lopez-Ibor, J., 2002, The power of stigma, World Psychiatry, 1, 1, 23-24.
- Markowitz, F. E., 1998, The effects of stigma on the psychological well-being and life satisfaction of persons with mental illness, Journal of Health and Social Behavior, 39, 335-347.
- Mind, 2000, Counting the costs : Mental health in the media, The Daily Stigma, Wednesday February 9, 2000.
- Muhlbauer, S., 2002, Experience of stigma by families with mentally ill members, Journal of the American Psychiatric Nurses Association, 8, 3, 76-83.
- Prince, P. N., Prince, C. R., 2002, Perceived stigma and community integration among clients of Assertive Community Treatment, Psychiatric Rehabilitation Journal, 25, 4, 323-331.
- Rabkin, J. G., Muhlin, G., Cohen, P. W., 1984, What the neighbors think : Community attitudes toward local psychiatric facilities, Community Mental Health Journal, 20, 4, 304-312.
- Rosen, A., Walter, G., Casey, D., Hocking, B., 2000, Combating psychiatric stigma : An overview of contemporary initiatives, Australian Psychiatry, 8, 1, 19-26.
- Rosen, G., 1993, A History of Public Health, Baltimore, Johns Hopkins University Press.
- Rothman, D., 1980, Conscience and Convenience : the Asylum and its Alternatives in Progressive America, Toronto, Little Brown and Company.
- Sartorius, N., 1997, Fighting schizophrenia and its stigma. A new World Psychiatric Association educational programme, British Journal of Psychiatry, 170, 297.
- Schulze, B., Angermeyer, M. C., 2003, Subjective experiences of stigma. A focus group study of schizophrenic patients, their relatives and mental health professionals, Social Sciences and Medicine, 56, 299-312.
- Segal, S. P., Baumohl, J., Moyles, E. W., 1980, Neighborhood types and community reaction to the mentally ill : A paradox of intensity, Journal of Health and Social Behavior, 21, 345-359.
- Stip, E., Caron, J., Lane, C. J., 2001, Schizophrenia : people’s perceptions in Quebec, Canadian Medical Association Journal, 164, 9, 1299-1300.
- Stuart, H., 2002, Consumer Preference Assessment. Results of the Southeastern Ontario Mental Health Community Comprehensive Assessment Project, Kingston, Southeastern Ontario Mental Health Implementation Task Force and Ministry of Health and Long Term Care.
- Stuart, H., 2003, Mental illness and violence : An overview, World Psychiatry, (in press).
- Stuart, H., Arboleda-Flórez, J., 2001, Community attitudes toward people with schizophrenia, Canadian Journal of Psychiatry, 46, 245-252.
- Thompson, A. H., Stuart, H., Bland, R. C., Arboleda-Flórez, J., Warner, R., Dickson, R. A., 2002, Attitudes about schizophrenia from the pilot site of the WPA worldwide campaign against the stigma of schizophrenia, Social Psychiatry and Psychiatric Epidemiology, 37, 475-482.
- Trute, B., Teft, B., Segall, A., 1989, Social rejection of the mentally ill : a replication study of public attitude, Social Psychiatry and Psychiatric Epidemiology, 24, 69-76.
- Wahl, O. F., 1999, Mental health consumers’experiences of stigma, Schizophrenia Bulletin, 25, 3, 467-478.
- Wahl, O. F., Harman, F. R., 1989, Family views of stigma, Schizophrenia Bulletin, 5, 1, 131-139.
- WHO, 2001, The World Health Report 2001 — Mental Health : New Understanding and Hope, Geneva, World Health Organization.
- Wolff, G., 1997, Attitudes of the Media and the Public, in Leff, J. ed., Care in the Community : Illusion or Reality ?, London, John Wiley and Sons Ltd.